| NPI | 1861407447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME0043881) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 13106) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2012-01-24 |